Drugs

Question 1

Anthracyclines

• name 1
• Mechanism
• Name 5 important side effects

Answer 1

Question 2

Amiodarone - class 3 anti-arrythmic

Answer 2

Question 3

Apixaban vs Warfarin

• Which is better at preventing stroke/embolism
• Which causes less bleeding
• Which results in lower mortality

Answer 3

Apixaban associated with:
-less major bleeding
-less death from any cause
-less haemorrhagic stroke
Ie Apixaban is superior to warfarin in preving stroke, systemic embolism. It causes less bleeding and resulted in lower mortality
ARISTOTLE Trial

Question 4

Aspirin mechanism of action

Answer 4

• Acetylsalicylic acid - irreversibly inactivates cyclo-oxygenase (COX) activity of platelet prostaglandin endoperoxide (PGH) synthase 1 -> suppresses thromboxane A2 production through platelet lifespan
• Thromboxane A2 - stimulates activation of new platelets + increases platelet aggregation.
• This is achieved by increasing expression of the glycoprotein complex GPIIb/IIIa on the cell membrane of platelets

Question 7

Class 1 anti-arrhythmic drugs

Answer 7

Question 8

Class I anti-arrhythmatics effect on cardiac AP

Answer 8

Question 9

Classes of Anti-arrhythmics

Answer 9

Question 10

Dihydropyridines vs non-dihydropyridine CCB

Answer 10

Question 11

Drug Class: PCSK9s

Answer 11

Question 12

Benefit of statin in CKD (eGFR < 60) in NON dialysis population (3)

Answer 12

1. Reduction in CVD mortality
2. Reduction in CVD events
3. Reduction in overall mortality
   (SHARP trial 2011)

Question 13

HF drugs and outcomes

Answer 13

Question 14

HFrEF drugs for symptomatic patients

Answer 14

• Note: diuretics have value in Sx Mx but their effects on mortality and morbidity have not been studied in RCTs
• Note2:Sacubitril/Valsartan (ARNI) is a replacement for ACEI with morb/mortality benefit in ambulatory patients with HFrEF who have ongoing Sx despite ACEI, BB, + MRA. Ivabradine can also be added if in SR, LVEF<35% and HR >70

Question 15

Cardioselective beta blockers

Answer 15

Cardioselective Beta blockers

• Atenolol
• Bisoprolol
• Metoprolol
• Nebivolol - most cardioselective

Question 21

Drugs which reduce rates of sudden death in HFrEF

Answer 21

Betablockers
MRAs (mineralcorticoid receptor antagonist)
ARNI (Sacubitril/Valsartan)
ACEI

Question 22

Ionotropes

Answer 22

Question 24

Rivaroxaban in ACS

• Mortality benefit?
• Risk of bleeding?

Answer 24

MACE = major adverse CV events

Question 25

NOACs: indications

Answer 25

AF with: AS, AR, MR
Aortic bioprostheses >3 months after implantation
Contraindicated in
-mitral stenosis
-mechanical valves
-APLS

Question 26

Rivaroxaban vs Warfarin

• Which is better at stroke/embolism prevention
• Which has more bleeding?
• Which has less intracranial and fatal bleeding

Answer 26

Question 27

Side effects of beta-blockers

Answer 27

Question 29

Rivaroxaban in recent ACS - ATLAS Trial

Answer 29

Rivaroxaban reduced risk of

• death from cardiovascular causes, myocardial infarction and stroke

Rivaroxaban increased risk of

• -major bleeding
• -intracranial haemorrhage BUT not risk of fatal bleeding

Question 32

Ticagrelor vs Clopidogrel in ACS

Answer 32

Ticagrelor in ACS (without or without ST elevation)

• reduced rate of death from vascular causes, MI, stroke
  
  • Without an increase in rate of overall major bleeding
  • BUT with an increase in the rate of non-procedure related bleeding when compared to Clopidogrel
• Dyspnoea was more common in the ticagrelor group
• NEJM 2009